Thursday, September 13, 2007

Ethics and Elbow Grease

Organizational ethics isn’t just about hospitals, group practices and health plans.The larger system within which health care occurs can usefully be regarded as a form of organization structured – for better or worse – around values. Advancing key values requires elbow grease. And time.

The mental health peer support movement provides a superb example of the role of elbow grease in changing the ethos of the health system. For the past 10 -15 years mental health consumer activists have been advocating for a “recovery orientation” – approaching those with serious mental disorders in a spirit of optimism about their futures and a focus on what will contribute to a meaningful and satisfying life. They want a person-centric – not professional-centric – care and support system.

Peer support services offered by individuals who are themselves in recovery from mental health and substance abuse disorders is an important manifestation of the recovery orientation. Georgia was the first state to offer these services. Consumer advocate Larry Fricks labored in the trenches for years to create a training program for peers and get Georgia Medicaid to pay for peer services. South Carolina saw what Georgia did and was next. Other states followed.

Last month CMS put its imprimatur on peer services by issuing a “Dear State Medicaid Director” advisory about the rationale for peer services and the prerequisites for getting these services paid for. In Churchill’s terms the advisory isn’t the end of professional-centrism in the care system or even the beginning of the end, but it is certainly the end of the beginning. It has taken countless hours of hard work by consumer advocates and their allies to create the infrastructure and the evidence that allows this kind of change.

Good ethics and elbow grease make a potent combination!

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